Fecal immunochemical test accuracy in familial risk colorectal cancer screening

• Published in: International journal of cancer Vol. 134; no. 2; pp. 367 - 375
• Main Authors: Castro, Inés, Cubiella, Joaquín, Rivera, Concepción, González‐Mao, Carmen, Vega, Pablo, Soto, Santiago, Hernandez, Vicent, Iglesias, Felipe, Teresa Alves, María, Bujanda, Luis, Fernández‐Seara, Javier
• Format: Journal Article
• Language: English
• Published: Hoboken, NJ Wiley-Blackwell 15-01-2014; Wiley Subscription Services, Inc
• Subjects: Accuracy; adenoma; Biological and medical sciences; Cancer; Colonoscopy; Colorectal cancer; colorectal neoplasms; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - economics; Colorectal Neoplasms - genetics; Confidence intervals; Cost-Benefit Analysis; Cross-Sectional Studies; Double-Blind Method; early detection of cancer; Early Detection of Cancer - methods; Feces - chemistry; Female; Follow-Up Studies; Gastroenterology. Liver. Pancreas. Abdomen; Genetic Predisposition to Disease; Hemoglobins - analysis; Humans; Male; Medical research; Medical sciences; Medical screening; Middle Aged; Multiple tumors. Solid tumors. Tumors in childhood (general aspects); Neoplasm Staging; occult blood; Prognosis; Prospective Studies; ROC Curve; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Tumors; occult blood; Rectal disease; Colorectal cancer; Risk; Adenoma; Cost benefit analysis; Blood; Cancerology; early detection of cancer; colorectal neoplasms; cost-benefit analysis; Intestinal disease; Familial cancer; Benign neoplasm; Diagnosis; Feces; Malignant tumor; Medical screening; Colonic disease; Health economy; Risk factor; Digestive diseases; Early; Detection; Cancer; adenoma
• ISSN: 0020-7136; 1097-0215
• DOI: 10.1002/ijc.28353

There is little information on fecal immunochemical test (FIT) in familial risk colorectal cancer (CRC) screening. Our study assesses FIT accuracy, number needed to scope (NNS) and cost to detect a CRC and an advanced neoplasia (AN) in this setting. We performed a multicentric, prospective, double‐blind study of diagnostic tests on individuals with first‐degree relatives (FDRs) with CRC submitted to screening colonoscopy. Two stool samples were collected and fecal hemoglobin in the first sample (FIT1) and the highest in both samples (FITmax) were determined. Areas under the curve (AUC) for CRC and AN as well as the best FIT1 and FITmax cutoff value for CRC were determined. At this threshold, NNS and the cost per lesion detected were calculated. A total of 595 individuals were included (one FDR > 60 years, 413; two FDR or one ≤ 60 years, 182). AN and CRC were found in 64 (10.8%) and six (1%) patients, respectively. For CRC diagnosis, FIT1 AUC was 0.96 [95% confidence interval (CI): 0.95–0.98] and FITmax AUC was 0.95 (95% CI: 0.93–0.97). For AN diagnosis, FIT1 and FITmax AUC were 0.74 (95% CI: 0.66–0.82). The best cutoff point for CRC was 115. At this threshold, the NNS to detect a CRC was 5.67 and 7.67, and the cost per CRC was 1,064€ and 1591.33€ on FIT1 and FITmax strategies, respectively. FIT shows high accuracy to detect CRC in familial CRC screening. Performing two tests does not improve diagnostic accuracy, but increases cost and NNS to detect a lesion.
What's new?
A new study assessed the cost‐effectiveness and accuracy of using the fecal immunochemical test, FIT, to detect colorectal cancer. The test detects the amount of hemoglobin in a stool sample; higher levels indicate the presence of cancer. The authors administered the test to people who had no symptoms yet, but did have a close relative with colorectal cancer and had been referred for colonoscopy. They determined that the FIT has a high diagnostic accuracy for familial screening of CRC and costs less per lesion detected than colonoscopy.